Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehad428. https://doi.org/10.1093/eurheartj/ehad428 Dr. Marco Bergonti et al.
Points
- The study aimed to validate the Antwerp score, a four-parameter prediction model, in a large European multi-center cohort of 605 patients with atrial fibrillation (AF) and heart failure (HF) undergoing AF ablation.
- External validation of the Antwerp score demonstrated good discrimination and calibration, with an AUC of 0.86 (95% CI 0.82–0.89) and a p-value of 0.29 for the Hosmer–Lemeshow test.
- Patients with Antwerp scores < 2 had a 93% probability of left ventricular ejection fraction (LVEF) recovery after AF ablation, while those with scores > 3 had only a 24% probability.
- Responders to AF ablation (70% of patients) with LVEF recovery experienced positive ventricular remodeling and had lower rates of HF hospitalizations (OR 0.09, 95% CI 0.05–0.18) and mortality (OR 0.11, 95% CI 0.04–0.31).
- The findings support using the Antwerp score in clinical decision-making and referral for AF ablation in patients with concomitant AF and HF with LVEF <50%.
Summary
The research paper aimed to externally validate the Antwerp score in a large European multi-center cohort comprising 605 patients (mean age 61.1 ± 9.4 years) with concomitant atrial fibrillation (AF) and heart failure (HF). Among these patients, 23.8% were females, and 79.8% had persistent AF. All patients had impaired left ventricular ejection fraction (LVEF) levels below 50% and underwent AF ablation.
The validation results of the Antwerp score in this cohort demonstrated good discrimination and calibration, with an area under the curve (AUC) of 0.86 and a 95% confidence interval (CI) of 0.82–0.89 (P < 0.001). The Hosmer–Lemeshow test showed a p-value of 0.29, indicating adequate calibration. The Antwerp score relied on four parameters: QRS duration greater than 120 ms, known HF etiology, paroxysmal AF, and severe atrial dilation. Patients with a score of less than 2 had an impressive 93% probability of LVEF recovery after AF ablation, in contrast to only 24% in patients with a score greater than 3.
Furthermore, the study revealed that the patients who responded to AF ablation, as determined by LVEF recovery, experienced favorable clinical outcomes. These responders had a significantly higher likelihood of positive ventricular remodeling (odds ratio [OR] 8.91, 95% CI 4.45–17.84, P < 0.001) and lower rates of HF hospitalizations (OR 0.09, 95% CI 0.05–0.18, P < 0.001) and mortality (OR 0.11, 95% CI 0.04–0.31, P < 0.001) compared to non-responders.
In conclusion, the data from this multicenter study affirm the validity of the Antwerp score as a valuable and straightforward prediction model for estimating LVEF recovery after AF ablation in patients with heart failure and atrial fibrillation. The score’s ability to discriminate clinical outcomes emphasizes its potential to guide shared decision-making for AF ablation referral in this patient population. By identifying patients with higher probabilities of LVEF recovery, the Antwerp score may aid in optimizing treatment strategies and improving overall clinical outcomes in this complex and challenging patient group.
Link to the article: https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehad428/7211656
References Bergonti, M., Ascione, C., Marcon, L., Pambrun, T., Della Rocca, D. G., Ferrero, T. G., Pannone, L., Kühne, M., Compagnucci, P., Bonomi, A., Gevaert, A. B., Anselmino, M., Casella, M., Krisai, P., Tondo, C., Rodríguez-Mañero, M., Derval, N., Chierchia, G.-B., De Asmundis, C., … Sarkozy, A. (2023). Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: A prediction model. European Heart Journal, ehad428. https://doi.org/10.1093/eurheartj/ehad428
